Elbow Flexion Test | Cubital Tunnel Syndrome Assessment

Cubital tunnel syndrome is a peripheral entrapment neuropathy of the ulnar nerve at the elbow. It’s the second most common entrapment neuropathy of the upper limb and is commonly seen after trauma resulting in a fracture or dislocation at the elbow, arthritis, or repetitive strain.

Sensitivity ranged from 36% to 93% and specificity from 40% to 99%  in different studies. No pooling is possible as the test executions were not identical and different cut-off values were used for what constitutes a positive test. Furthermore, the quality of the studies varied, which is why we give the test at best a moderate clinical value.

To conduct the test according to its original description, the patient is standing or sitting. With the patient’s arms in the anatomical position, the elbows are maximally flexed, the forearms maximally supinated and the wrist is placed into extension. This position is maintained for up to 3 minutes.

The test is positive in case of the reproduction of pain, tingling, or numbness along the distribution of the ulnar nerve during the three minutes.  The reasoning for this test is that the aponeurosis of the two heads of the flexor carpi ulnaris, which forms the cubital tunnel is drawn taut over the nerve with elbow flexion which results in compression of the ulnar nerve.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Other orthopedic tests to assess for cubital tunnel syndrome are:

• Tinel’s Sign at the Elbow
• Scratch Collapse Test
• Pressure Provocation Test
• Shoulder Internal Rotation Test

References

Rosati, M., Martignoni, R., Spagnolli, G., Nesti, C., & Lisanti, M. (1998). Clinical validity of the elbow flexion test for the diagnosis of ulnar nerve compression at the cubital tunnel. Acta orthopaedica belgica, 64, 366-370.

Novak, C. B., Lee, G. W., Mackinnon, S. E., & Lay, L. (1994). Provocative testing for cubital tunnel syndrome. The Journal of hand surgery, 19(5), 817-820.

Ochi, K., Horiuchi, Y., Tanabe, A., Morita, K., Takeda, K., & Ninomiya, K. (2011). Comparison of shoulder internal rotation test with the elbow flexion test in the diagnosis of cubital tunnel syndrome. The Journal of hand surgery, 36(5), 782-787.

Beekman, R., Schreuder, A. H. C. M. L., Rozeman, C. A. M., & Koehler, P. J. (2009). The diagnostic value of provocative clinical tests in ulnar neuropathy at the elbow is marginal. Journal of Neurology, Neurosurgery & Psychiatry, 80(12), 1369-1374.

Buehler, M. J., & Thayer, D. T. (1988). The elbow flexion test. A clinical test for the cubital tunnel syndrome. Clinical orthopaedics and related research, (233), 213-216.

Cheng, C. J., Mackinnon-Patterson, B., Beck, J. L., & Mackinnon, S. E. (2008). Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. The Journal of hand surgery, 33(9), 1518-1524.